Successful Treatment of COVID-19-Related Immune- Complex Glomerulonephritis, Case Report.

Acute kidney injury (AKI) , proteinuria in the nephrotic or subnephrotic range and hematuria might be seen in patients with coronavirus disease 2019 (COVID-19) infection. In this case study we present a 59 years old manwho was diagnosed with immune-complex glomerulonephritis after development of rapidly progressive kidney failure accompanied by pulmonary hemorrhage, 2 months after COVID-19 infection. The patient was hospitalised with the diagnosis of acute kidney injury and nephrotic syndrome. Hemodialysis was performed due to uremic symptoms. Cyclophosphamide, methylprednisolone and plasmapheresis were started. Pathologic examination of kidney biopsy revealed features compatible with immune complex-related acute glomerulonephritis. Cyclophosphamide and plasmapheresis were discontinued , and treatment with 1 mg/kg/day methylprednisolone was continued. Immune-complex glomerulonephritis can be seen following COVID-19 infection. It is important to diagnose this disease entity as soon as possible . Steroidtherapy and other supportive modalities might be sufficient in the treatment.  DOI: 10.52547/ijkd.6527.

The atherogenic index of plasma as a predictor of mortality in patients with COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global health threat, and thus, an early and effective set of predictors is needed to manage the course of the disease. OBJECTIVES: We aim to determine the effect of SARS-CoV-2 on lipid profile and to evaluate whether the atherogenic index of plasma (AIP) could be used to predict in-hospital mortality in COVID-19 patients. METHODS: In this retrospective chart review study, a total of 139 confirmed COVID-19 patients, whose diagnoses are confirmed by PCR and computerized tomography results, are enrolled. The study population is divided into two groups: the deceased patient group and the survivor group. For each patient, fasting total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and the triglyceride values are obtained from the laboratory tests required at the admission to hospital. Finally, the AIP is calculated as the base 10 logarithm of the triglyceride to HDL-C ratio. Distributional normality of the data is checked and depending on the normality of the data, either T test or Mann Whithey U test is employed to compare the two aforementioned study groups. RESULTS: Mean age of the study population is 49.2 ± 20.8 and 61.2% (n = 85) is male. Out of the 139 patients 26 have deceased and the remaining 113 patients survived the disease. Mean age of the deceased patients was 71.8*8.9 and mean age of the survivor patients is 44.0*19.2 (p < 0.001). The deceased group had more patients with hypertension (50.0% vs. 23.0, p = 0.006), diabetes mellitus (35.6% vs. 10.6%, p = 0.002), cardiovascular diseases (23.1% vs. 4.4%, p = 0.001), chronic renal insufficiency (11.5% vs. 0.9%, p = 0.003) and atrial fibrillation (7.7% vs 0%, p = 0.003). The AIP values in the deceased group are found to be statistically higher (p < 0.001) than the survivor group. As a measure of mortality, the area under the operating characteristic curve for the AIP is calculated as 0.850 (95% confidence interval: 0.772-0.928) along with the optimal cut-off value of 0.6285 (78.6% sensitivity and 80.5% specificity). Furthermore, the AIP value is observed to be elevated in patients with pneumonia, intubation history, and intensive care admission during hospital stay (p = 0.002, p < 0.001 and p < 0.001, respectively). Finally, compared to the survivor group, total cholesterol, HDL-C, LDL-C values are lower (p = 0.004, p < 0.001 and p < 0.001, respectively) and triglyceride levels are higher (p < 0.001) in deceased patients. CONCLUSION: In this study, we show that the AIP levels higher than 0.6285 can predict in-hospital mortality for COVID-19 patients. Moreover, the AIP emerges as a good candidate to be used as an early biomarker to predict pneumonia, intubation and intensive care need. Hence, regular check of the AIP levels in COVID-19 patients can improve management of these patients and prevent deterioration of the disease.

Premature or nevoid sebaceous hyperplasia? Two case reports of a rare disease.

Early or familial cases of sebaceous hyperplasia (SH) with multiple lesions, thought to be associated with genetic predisposition, have been reported in young individuals. Rarely reported variants include the giant, diffuse, zosteriform, and/or linear (nevoid) form. However, premature SH, defined as benign proliferation of sebaceous glands that occurs during or after puberty, is histologically similar to SH. Whether the definitions of nevoid SH or premature SH are the same remains unclear. We report two sporadic cases of premature SH.

Can the Human Tail Cause Arteriovenous Hemangioma?

INTRODUCTION: "Human tail" is a congenital, benign anomaly in which a protrusion in the lumbosacrococcygeal caudal region is covered with skin. Arteriovenous hemangioma is a benign vascular lesion that may be congenital or acquired. We present a case in which a human tail was present with pathological findings of arteriovenous hemangioma. CASE REPORT: A 6-month-old girl was born with a curved tail-shaped protrusion along her waistline. The distal portion was purple and had a solid consistency; the proximal portion was of normal skin color and had a soft consistency. No other abnormality was observed in the spinal area. Microscopic examination revealed congested, proliferated vascular structures in the fibrous stroma distally located under the multilayered squamous epithelium. In the proximal area, mature lipomatous tissue was observed. The lesion was diagnosed as arteriovenous hemangioma. CONCLUSION: Our patient presented with the classic "human tail" appearance at an early age and in the lumbosacral region. Because of the pathological findings, surgery for the congenital anomaly had to be performed with extra caution.

The relationship of mast cell density in pulmonary, gastric and ovarian malignant epithelial tumors with tumor necrosis and vascularization.

Although many studies have been conducted to explore the relationship between mast cells (MC) and angiogenesis, comparison of this relationship with tumor necrosis has not been investigated to the best of our knowledge. Therefore, the relationship between MC and neovascularization in stomach, lung and ovarian malignant epithelial tumors (165 cases) in necrotizing or non-necrotizing cases was explored in this study. We immunohistochemically studied anti-mast cell tryptase antibody for MC and anti-CD34 antibody for vascular structures. MCs in the intra- tumoral and peritumoral fields, as well as vascular structures with luminal and monocellular appearances in the intratumoral field, were counted in each sample. Ten magnification fields were analyzed for each sample. In stomach and lung cases, the non-necrotizing group exhibited a greater number of MC and vascular structures in total. In ovarian cases, more MCs were counted overall in the necrotizing group, but there were fewer vascular structures. The increase in the number of MC and vascular structures in lungs and stomach in the non-necrotizing group supports the theory that MCs are involved in tumor progression. Necrosis, which can be induced on the basis of restricted neovascularization through inhibition of MCs in lung and stomach tumors, may be a treatment method.

Bradyarrhythmia due to mirtazapine overdose: A case of serious adverse event in a suicidal patient.

There are a limited number of studies on postoverdose clinical findings of mirtazapine in the literature. Our case presented an unlikely junctional rhythm, which we have not seen in the previous studies, in a patient who had bradycardia and hypotension following mirtazapine intake. A 37-year old male was admitted to the emergency department (ED) after his suicide attempt with 300 mg PO of mirtazapine tablets. He took the drug 2 h prior to his ED visit. He did not have any complaints after the mirtazapine intake. His complete physical examination and electrocardiography (ECG) revealed no pathological findings. He was observed in the ED. The results were in the normal range in his blood test and he has 0 mg/dl of blood ethanol. He experienced dizziness after 5 h and 30 min. The blood pressure was 60/30 mmHg. The heart rate was 34 beats/min. The simultaneous ECG showed junctional bradycardia. 0.5 mg atropine IV was given two times at intervals. Norepinephrine infusion was initiated after normal saline therapy. Forty-five minutes later, he did not have any clinically significant complaint. There are no pathological findings in his follow-up ECG and physical examination. He was discharged of his own accord 10 h after his ED admission. His initial mirtazapine level was 145 ng/ml when he came to the ED. Mirtazapine was known to have a safe cardiac profile both for regular dose and overdose. However, physicians should consider that it might induce a life-threatening bradyarrhythmia.

Evaluation of the Tp-e interval and Tp-e/QTc ratio in patients with benign paroxysmal positional vertigo in the emergency department compared with the normal population.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is a common diagnosis for dizziness patients admitting to emergency department and for initial diagnosis, cardiac causes of dizziness should be excluded at admittance. Electrocardiography (ECG) is a simple method to detect cardiac arrhythmias for these patients. Tp-e interval and Tp-e/QTc ratio are transmural repolarization parameters and shown to be strongly related to ventricular arrhythmias. With this study, we aim to investigate ventricular repolarization parameters like Tp-e interval and Tp-e/QTc ratio which can be easily evaluated by ECG in BPPV patients. MATERIALS AND METHODS: A total of 84 newly diagnosed BPPV patients and 59 age-sex matched control group without dizziness symptoms compatible with inclusion criteria were included for the study. Patients with previous vertigo, coronary artery disease, renal disease, heart failure, severe valvular disease, arrhythmia history, electrolyte disturbances and patients under 18 years of age were excluded. RESULTS: Mean age of the study population was 44.4 ±â€¯12.1 years, 36.4% were male. There was no significant difference among groups in terms of age, sex, diabetes mellitus, hypertension and hypothyroidism history. When ECG results were evaluated QRS interval, QT interval, Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were statistically higher in BPPV patients compared to control group (p = 0.000, p = 0.047, p = 0.000, p = 0.000 and p = 0.001, respectively). DISCUSSION: As a result of our study, Tp-e and Tp-e/QTc ratio were significantly higher in BPPV patients compared to the control group. These findings suggest that ventricular arrhythmia risk may be higher in BPPV patients. Further evaluation of these patients in terms of ventricular arrhythmia would be beneficial.

Dermoscopy of oral mucocele: three types of extravasation mucoceles

Background/aim: Dermoscopy is a diagnostic tool that assists in imaging the epidermis and dermis. Although it has also started to be used to diagnose nonmelanocytic lesions recently, it has not been tested much on oral mucosal masses, such as oral mucoceles. This study aimed to investigate whether dermoscopy is a valuable tool in diagnosing oral mucoceles. Materials and methods: In this study, the clinical and dermoscopic features of 21 oral mucocele lesions of 21 patients (11 females, 10 males) aged between 6 and 38 years who were confirmed histopathologically were evaluated. Results: Of the lesions studied, 95.2% (20) were extravasation and 4.8% (1) were retention mucoceles. The nonvascular structures were determined as white areas (61.9%, 13), erythema (57.1%, 12), purplish-gray background (52.3%, 11), ulcer (30%, 8), yellowish- orange areas (23.8%, 5), crust (14.2%, 3), starburst pattern (0.95%, 2), and bleeding (0.47%, 1). Dermoscopically, 40% of extravasation mucoceles were classified as type 1 (8 patients), 25% as type 2 (5 patients), and 35% as type 3 (7 patients). Conclusion: We concluded that there are 3 types of extravasation mucoceles dermoscopically and clinically, and these types may be stages of transition between each other.

Factors that Affect Drain Indwelling Time after Breast Cancer Surgery.

OBJECTIVE: The most common procedure to prevent seroma formation, a common complication after breast and axillary surgery, is to use prophylactic surgical drains. Ongoing discussions continue regarding the ideal time for removing drains after surgical procedures. In this study, we aimed to investigate factors that affect drain indwelling time (DIT). MATERIALS AND METHODS: From 2014 to 2015, a total of 91 consecutive patients with breast cancer were included in the study. The demographic characteristics of the patients, treatment methods, histopathologic features of the tumor, size of removed breast tissue (BS), tumor size (TS), number of totally removed lymph nodes (TLN), and metastatic lymph nodes (MLN), whether they had neoadjuvant chemotherapy, and the DIT were retrospectively recorded from the hospital database. RESULTS: The mean age of the patients was 48.9 years, and the mean DIT was 4.8 days. The mean size of breast removed was 17.3 cm and tumor size was 4.7 cm, and the mean number of metastatic lymph nodes was 3.3, and mean total number of lymph nodes was 14.1. Patients who had neoadjuvant chemotherahpy had longer DIT. There was a positive correlation between the BS, TS, TLN, MLN, length of hospital stay, and DIT. Linear regresion analysis revealed that the BS, TLN, and history of neoadjuvant chemotherahpy were independent risk factors for DIT. CONCLUSION: DIT primarily depends on BS, TLN, and history of neoadjuvant chemotherahpy. A policy for the management of removing drains to prevent seroma formation should thus be individualized.

A study on the evaluation of pneumothorax by imaging methods in patients presenting to the emergency department for blunt thoracic trauma.

BACKGROUND: Pneumothorax (PNX) is the collection of air between parietal and visceral pleura, and collapsed lung develops as a complication of the trapped air. PNX is likely to develop spontaneously in people with risk factors. However, it is mostly seen with blunt or penetrating trauma. Diagnosis is generally confirmed by chest radiography [posteroanterior chest radiography (PACR)]. Chest ultrasound (US) is also a promising technique for the detection of PNX in trauma patients. There is not much literature on the evaluation of blunt thoracic trauma (BTT) and pneumothorax (PNX) in the emergency department (ED). The aim of this study was to investigate the effectiveness of chest US for the diagnosis of PNX in patients presenting to ED with BTT. METHODS: This study was carried out for a period of nine months in the ED of a university hospital. The chest US of patients was performed by emergency physicians trained in the field. The results were compared with anteroposterior chest radiography and/or CT scan of the chest. The APCR and chest CT results were evaluated by a radiology specialist blind to US findings. The evaluation of the radiology specialist was taken as the gold standard for diagnosis by imaging methods. Clinical follow-up was taken into consideration for the diagnosis of PNX in patients on whom CT scan was not performed. RESULTS: Chest US was performed on all two hundred and twelve patients (144 female and 68 male patients; mean age 45.8) who participated in this study. The supine APCR was performed on two hundred and ten (99%) patients and chest CT was performed on one hundred and twenty (56.6%). Out of the twenty-five (11.8%) diagnosed cases of PNX, 22 (88%) were diagnosed by chest US and 8 were diagnosed by APCR. For the detection of PNX, compared to clinical follow-up and chest CT, the sensitivity of chest US was 88%, specificity 99.5%, positive predictive value 95.7% and negative predictive value 98.4%. CONCLUSION: Chest US has not superseded supine and standing chest radiography for PNX diagnosis yet in many healthcare centers, but it is performed by emergency physicians and it is an effective and important method for early and bedside diagnosis of PNX.

Characteristics of Patients Presenting to the Academic Emergency Department in Central Anatolia.

OBJECTIVES: Determining the properties of patients admitted to the emergency department (ED) is important to plan for future and quality assurance. In this study, we aimed to evaluate the properties of patients admitted to our ED to improve the quality of care within our hospital. METHODS: In the study period, the patients: (i) who have their full information in hospital information and management system (HIMS) and (ii) older than 17 years of age were included into the study. Demographic information, admission and discharge rates, mean staying time in the ED, triage categories, International Classification of Diseases - 10 (ICD-10) diagnoses were evaluated. RESULTS: During the study period, 32,117 cases were seen by the ED. However, 22,955 patients (71.4%) had complete information in the HIMS. The mean age was 44.92±19.50 and female gender was found 52.2%. The patients who were located in 18-29 age group was the major group of all cases (30.8%). Emergent and urgent cases were 26.1% and 14.8%, respectively. Non-urgent cases were also found (59.1%). The mean age of patients located in the emergent group (55.19±18.59) were significantly higher than urgent and non-urgent group (p≤0.01). The highest patient volume was seen on Sunday, between 20:00 and 22:00 o'clock. The mean staying time in the ED was 183.6 minutes and the admission rate was 17.6%. The three most noted ICD-10 codes were respiratory (16.6%), gastrointestinal (11.3%), musculoskeletal (11.2%) codes. CONCLUSIONS: The data that was correctly uploaded into the system did not reach our expectation. Data can be more appropriately uploaded by medical secretaries. Registering patient information in a digital atmosphere while performing analyses will undoubtedly have an effect on future focused studies.